二维及三维超声心动图参数评估希氏束起搏治疗慢性心力衰竭伴左束支传导阻滞效果

目的筛选超声心动图评估希氏束起搏(HBP)治疗慢性心力衰竭(CHF)伴左束支传导阻滞(LBBB)疗效的指标。方法回顾性分析28例CHF伴LBBB患者HBP术前及术后1、3、6个月超声心动图,二维参数包括左心房前后径(LAD)、左心室舒张末期内径(LVEDD)、心室间机械延迟(IVMD)时间及二尖瓣最大反流面积,三维参数包括左心室射血分数(LVEF)、左心室舒张及收缩末期容积(LVEDV、LVESV)、每搏量(LVSV)、左心室16节段达最小收缩容积时间最大差(Tmsv16-Dif%)和标准差(Tmsv16-SD%)。结果术后1、3、6个月LAD、LVEDD、LVSV、LVEDV、LVESV、IVMD、Tmsv16-SD%及Tmsv16-Dif%均低于术前(P均<0.05),而LVEF高于术前(P<0.01)。术后6个月LVSV、LVEDV、LVESV及IVMD均低于术后1个月(P均<0.05),LVEF高于术后1个月(P<0.01)。术后6个月71.43%(20/28)患者二尖瓣反流程度较术前改善。结论HBP治疗CHF伴LBBB效果良好;LVEF、IVMD、Tmsv16-SD%、Tmsv16-Dif%及MR改善是超声心动图评估HBP疗效的敏感指标。

Indexes of two-and three-dimensional echocardiography for evaluation on effect of His bundle pacing for treating chronic heart failure with left bundle-branch block

Objective To screen the indexes of ultrasound for evaluation on therapeutic effect of His bundle pacing (HBP) in patients with chronic heart failure (CHF) and left bundle-branch block (LBBB). Methods Echocardiographic parameters of 28 CHF-LBBB patients before and 1, 3 and 6 months after HBP were retrospectively analyzed, including two-dimensional indexes as left atrium diameter (LAD), left ventricular end diastolic diameter (LVEDD), interventricular mechanical delay (IVMD) time and mitral regurgitation (MR), also three-dimensional echocardiographic parameters as left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular stroke volume (LVSV), the maximum difference and standard deviation of left ventricle 16 segments reached time to minimum systolic volume (T_msv16-Dif% and T_msv16-SD%). Results One, 3 and 6 months after HBP, LAD, LVEDD, LVSV, LVEDV, LVESV, IVMD, T_msv16-Dif% and T_msv16-SD% were all lower than those before HBP (all P<0.05), while LVEF was higher than those before HBP (P<0.01). Compared with 1 month after HBP,LVSV, LVEDV, LVESV and IVMD 6 months after HBP were all lower (all P<0.05), while LVEF was than higher (P<0.01). Six months after HBP, MV was improved in 71.43% (20/28) patients. Conclusion CHF complicated with LBBB could be effectively treated with HBP. LVEF, IVMD, T_msv16-Dif%, T_msv16-SD% and MR improvement were sensitive indicators for postoperative evaluation with echocardiography.